AVNRT natural history, complications and prognosis: Difference between revisions
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AVNRT starts and stops abruptly. Patients may develop [[syncope]]. The prognosis is good. | AVNRT starts and stops abruptly. Patients may develop [[syncope]]. The prognosis is good. | ||
==Natural History, Complications | ==Natural History, Complications and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
The rhythm often ceases abruptly and spontaneously. An episode generally last seconds to hours. | The rhythm often ceases abruptly and spontaneously. An episode generally last seconds to hours. | ||
===Complications=== | ===Complications=== | ||
*Some patients will develop [[syncope]] during episodes of AVRNT. The mechanism of syncope may be due to a reduction of [[cardiac output]] and [[hemodynamic compromise]] as a result of the short ventricular filling time or alternatively it may be due to transient [[asystole]] due to tachycardia-mediated suppression of the sinus node when the rhythm terminates. Those patients who do become symptomatic during episodes of AVNRT (i.e. have [[syncope]]) should avoid activities where the occurrence of [[hemodynamic compromise]] would endanger their safety or that of others (like driving). | *Some patients will develop [[syncope]] during episodes of AVRNT. <ref name="LeitchKlein1992">{{cite journal|last1=Leitch|first1=J W|last2=Klein|first2=G J|last3=Yee|first3=R|last4=Leather|first4=R A|last5=Kim|first5=Y H|title=Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response?|journal=Circulation|volume=85|issue=3|year=1992|pages=1064–1071|issn=0009-7322|doi=10.1161/01.CIR.85.3.1064}}</ref>The mechanism of syncope may be due to a reduction of [[cardiac output]] and [[hemodynamic compromise]] as a result of the short ventricular filling time or alternatively it may be due to transient [[asystole]] due to tachycardia-mediated suppression of the sinus node when the rhythm terminates.<ref name="MoyaSutton2009">{{cite journal|last1=Moya|first1=A.|last2=Sutton|first2=R.|last3=Ammirati|first3=F.|last4=Blanc|first4=J.-J.|last5=Brignole|first5=M.|last6=Dahm|first6=J. B.|last7=Deharo|first7=J.-C.|last8=Gajek|first8=J.|last9=Gjesdal|first9=K.|last10=Krahn|first10=A.|last11=Massin|first11=M.|last12=Pepi|first12=M.|last13=Pezawas|first13=T.|last14=Granell|first14=R. R.|last15=Sarasin|first15=F.|last16=Ungar|first16=A.|last17=van Dijk|first17=J. G.|last18=Walma|first18=E. P.|last19=Wieling|first19=W.|last20=Abe|first20=H.|last21=Benditt|first21=D. G.|last22=Decker|first22=W. W.|last23=Grubb|first23=B. P.|last24=Kaufmann|first24=H.|last25=Morillo|first25=C.|last26=Olshansky|first26=B.|last27=Parry|first27=S. W.|last28=Sheldon|first28=R.|last29=Shen|first29=W. K.|last30=Vahanian|first30=A.|last31=Auricchio|first31=A.|last32=Bax|first32=J.|last33=Ceconi|first33=C.|last34=Dean|first34=V.|last35=Filippatos|first35=G.|last36=Funck-Brentano|first36=C.|last37=Hobbs|first37=R.|last38=Kearney|first38=P.|last39=McDonagh|first39=T.|last40=McGregor|first40=K.|last41=Popescu|first41=B. A.|last42=Reiner|first42=Z.|last43=Sechtem|first43=U.|last44=Sirnes|first44=P. A.|last45=Tendera|first45=M.|last46=Vardas|first46=P.|last47=Widimsky|first47=P.|last48=Auricchio|first48=A.|last49=Acarturk|first49=E.|last50=Andreotti|first50=F.|last51=Asteggiano|first51=R.|last52=Bauersfeld|first52=U.|last53=Bellou|first53=A.|last54=Benetos|first54=A.|last55=Brandt|first55=J.|last56=Chung|first56=M. K.|last57=Cortelli|first57=P.|last58=Da Costa|first58=A.|last59=Extramiana|first59=F.|last60=Ferro|first60=J.|last61=Gorenek|first61=B.|last62=Hedman|first62=A.|last63=Hirsch|first63=R.|last64=Kaliska|first64=G.|last65=Kenny|first65=R. A.|last66=Kjeldsen|first66=K. P.|last67=Lampert|first67=R.|last68=Molgard|first68=H.|last69=Paju|first69=R.|last70=Puodziukynas|first70=A.|last71=Raviele|first71=A.|last72=Roman|first72=P.|last73=Scherer|first73=M.|last74=Schondorf|first74=R.|last75=Sicari|first75=R.|last76=Vanbrabant|first76=P.|last77=Wolpert|first77=C.|last78=Zamorano|first78=J. L.|title=Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)|journal=European Heart Journal|volume=30|issue=21|year=2009|pages=2631–2671|issn=0195-668X|doi=10.1093/eurheartj/ehp298}}</ref> Those patients who do become symptomatic during episodes of AVNRT (i.e. have [[syncope]]) should avoid activities where the occurrence of [[hemodynamic compromise]] would endanger their safety or that of others (like driving). | ||
*In patients with underlying [[ischemic heart disease]], demand-related [[myocardial ischemia]], [[angina]] and even [[myocardial infarction]] and/or [[congestive heart failure]] can occur. | *In patients with underlying [[ischemic heart disease]], demand-related [[myocardial ischemia]], [[angina]] and even [[myocardial infarction]] and/or [[congestive heart failure]] can occur. | ||
*[[Tachycardia mediated cardiomyopathy]] may develop if the AVNRT is chronic and does not terminate. | *[[Tachycardia mediated cardiomyopathy]] may develop if the AVNRT is chronic and does not terminate. | ||
===Prognosis=== | ===Prognosis=== | ||
AVNRT is rarely life threatening and in the absence of underlying structural heart disease, the prognosis is good. Radiofrequency ablation is curative in 95% of cases. | AVNRT is rarely life threatening and in the absence of underlying structural heart disease, the prognosis is good. Radiofrequency ablation is curative in 95% of cases.<ref name="O’HaraPhilippon2007">{{cite journal|last1=O’Hara|first1=Gilles E.|last2=Philippon|first2=François|last3=Champagne|first3=Jean|last4=Blier|first4=Louis|last5=Molin|first5=Franck|last6=Côté|first6=Jean-Marc|last7=Nault|first7=Isabelle|last8=Sarrazin|first8=Jean-François|last9=Gilbert|first9=Marcel|title=Catheter ablation for cardiac arrhythmias: A 14-year experience with 5330 consecutive patients at the Quebec Heart Institute, Laval Hospital|journal=Canadian Journal of Cardiology|volume=23|year=2007|pages=67B–70B|issn=0828282X|doi=10.1016/S0828-282X(07)71013-9}}</ref> | ||
==References== | ==References== | ||
Latest revision as of 19:26, 15 April 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Ramyar Ghandriz MD[2]
Overview
AVNRT starts and stops abruptly. Patients may develop syncope. The prognosis is good.
Natural History, Complications and Prognosis
Natural History
The rhythm often ceases abruptly and spontaneously. An episode generally last seconds to hours.
Complications
- Some patients will develop syncope during episodes of AVRNT. [1]The mechanism of syncope may be due to a reduction of cardiac output and hemodynamic compromise as a result of the short ventricular filling time or alternatively it may be due to transient asystole due to tachycardia-mediated suppression of the sinus node when the rhythm terminates.[2] Those patients who do become symptomatic during episodes of AVNRT (i.e. have syncope) should avoid activities where the occurrence of hemodynamic compromise would endanger their safety or that of others (like driving).
- In patients with underlying ischemic heart disease, demand-related myocardial ischemia, angina and even myocardial infarction and/or congestive heart failure can occur.
- Tachycardia mediated cardiomyopathy may develop if the AVNRT is chronic and does not terminate.
Prognosis
AVNRT is rarely life threatening and in the absence of underlying structural heart disease, the prognosis is good. Radiofrequency ablation is curative in 95% of cases.[3]
References
- ↑ Leitch, J W; Klein, G J; Yee, R; Leather, R A; Kim, Y H (1992). "Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response?". Circulation. 85 (3): 1064–1071. doi:10.1161/01.CIR.85.3.1064. ISSN 0009-7322.
- ↑ Moya, A.; Sutton, R.; Ammirati, F.; Blanc, J.-J.; Brignole, M.; Dahm, J. B.; Deharo, J.-C.; Gajek, J.; Gjesdal, K.; Krahn, A.; Massin, M.; Pepi, M.; Pezawas, T.; Granell, R. R.; Sarasin, F.; Ungar, A.; van Dijk, J. G.; Walma, E. P.; Wieling, W.; Abe, H.; Benditt, D. G.; Decker, W. W.; Grubb, B. P.; Kaufmann, H.; Morillo, C.; Olshansky, B.; Parry, S. W.; Sheldon, R.; Shen, W. K.; Vahanian, A.; Auricchio, A.; Bax, J.; Ceconi, C.; Dean, V.; Filippatos, G.; Funck-Brentano, C.; Hobbs, R.; Kearney, P.; McDonagh, T.; McGregor, K.; Popescu, B. A.; Reiner, Z.; Sechtem, U.; Sirnes, P. A.; Tendera, M.; Vardas, P.; Widimsky, P.; Auricchio, A.; Acarturk, E.; Andreotti, F.; Asteggiano, R.; Bauersfeld, U.; Bellou, A.; Benetos, A.; Brandt, J.; Chung, M. K.; Cortelli, P.; Da Costa, A.; Extramiana, F.; Ferro, J.; Gorenek, B.; Hedman, A.; Hirsch, R.; Kaliska, G.; Kenny, R. A.; Kjeldsen, K. P.; Lampert, R.; Molgard, H.; Paju, R.; Puodziukynas, A.; Raviele, A.; Roman, P.; Scherer, M.; Schondorf, R.; Sicari, R.; Vanbrabant, P.; Wolpert, C.; Zamorano, J. L. (2009). "Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)". European Heart Journal. 30 (21): 2631–2671. doi:10.1093/eurheartj/ehp298. ISSN 0195-668X.
- ↑ O’Hara, Gilles E.; Philippon, François; Champagne, Jean; Blier, Louis; Molin, Franck; Côté, Jean-Marc; Nault, Isabelle; Sarrazin, Jean-François; Gilbert, Marcel (2007). "Catheter ablation for cardiac arrhythmias: A 14-year experience with 5330 consecutive patients at the Quebec Heart Institute, Laval Hospital". Canadian Journal of Cardiology. 23: 67B–70B. doi:10.1016/S0828-282X(07)71013-9. ISSN 0828-282X.